Victory Vascular & General Surgery of Georgia PC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

040293 Issued in GA

Legal business name

VICTORY VASCULAR & GENERAL SURGERY OF GEORGIA PC

Practice address

435 Hawthorne Ave
#600
Athens, GA 30606-2574

Phone

(706) 227-0871

Fax

(706) 227-0865

NPI assigned

Mar 13, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Azeez Popoola Adeduntan, M.D

Title

President

Phone

(706) 227-0871

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Akinola O Akintade, SURGICAL ASSISTANT

  • Surgical Physician Assistant
  • Tucker, GA
  • NPI 1861760712
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358985600000",
    "number": "1851424378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 HAWTHORNE AVE",
            "address_2": "#600",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062574",
            "telephone_number": "706-227-0871",
            "fax_number": "706-227-0865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 HAWTHORNE AVE",
            "address_2": "#600",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062574",
            "telephone_number": "706-227-0871",
            "fax_number": "706-227-0865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY VASCULAR & GENERAL SURGERY OF GEORGIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2013-01-24",
        "status": "A",
        "authorized_official_last_name": "ADEDUNTAN",
        "authorized_official_first_name": "AZEEZ",
        "authorized_official_middle_name": "POPOOLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-227-0871",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "GA",
            "license": "040293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000670381C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kajene Thasan Vethanayagam, O.D.
• Marilyn Anne Vickers, PH.D.
• Courtney Vickery, MS, RD, LD
• Victor a. Morales, MD, PC
• Victor E Payton MD, PC
• Nedsely Ana Vila Almonte
• Village Drug Shop at Advantage LLC
• Village Drug Shop at Advantage LLC
• Village Drug Shop of Athens Inc
• Village Drug Shop of Athens Inc

• Vascular Surgery Physician in Athens, GA
• Providers in Athens, GA by specialty
• Vascular Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.